Rescheduling Part 2 of the 11+ Reduces Injury Burden and Increases Compliance in Semi-Professional Football

Whalan M, Lovell R, Steele JR, & Sampson JA.  Scand J Med Sci Sports. 2019; published online ahead of print. DOI:10.11111/sms.13532

Take Home Message

Soccer teams that completed the strength portion of the 11+ program at the end of a training session had better compliance and fewer ankle and severe injuries.


Soccer players who complete the 11+ program can reduce the risk of injury by more than 40%.  Despite the effectiveness of the 11+ program, adoption and compliance are poor partly because of the time required to complete the program and concern about fatigue from the warm-up.  Hence, these authors compared the compliance and effectiveness of the 11+ program among semi-professional teams when the program was offered traditionally or modified with parts 1 and 3 before training and part 2 (the strengthening portion) at the end of training.  The researchers trained one person with each team to record when a player completed the 11+ program at a session, injury data (e.g., time loss, severe injuries, injury locations) and exposure data (hours of soccer).  Each team performed the 11+ program at least twice per week during the 2017 season. Among the 25 teams, 2 teams that performed Part 2 after training and 3 teams that performed the traditional program failed to finish the study. Overall, the compliance was better among teams that performed Part 2 at the end of training (29 sessions vs. 19 sessions per player). However, compliance was still low to moderate for each group. The traditional program completed the 11+ program at only 33% of training sessions, and the other group completed the 11+ program at 58% of training sessions. The authors observed no differences between groups based on the number of total injuries. However, the teams that performed the modified 11+ with part 2 later had less total days lost (5,815 days vs. 4,303 days) probably because this group had fewer severe injuries (> 28 days lost).  The modified 11+ also had lower ankle and recurrent injuries, but the standard 11+ had lower quadriceps muscle injuries and contusions.


This study is very interesting because it demonstrates that the 11+ program can be done at different times during a training session and still reduce the risk of injury.  This is outstanding news because one of the barriers to the 11+ program is the completion of the strengthening exercises before activity on the field/court.  Based on these new findings, teams can perform these activities after the activity so that they feel more comfortable about completing these. This may explain why compliance was improved with this approach. It would be interesting to know if the Part 2 program could even be performed in the weight room instead of on-field.  It would be interesting to compare whether there would be any difference in injuries when both groups performed the same number of 11+ sessions.  Furthermore, it would be interesting to pair this new approach to the 11+ program to other strategies to maximize compliance. Clinicians should work with coaches to tailor injury prevention programs to fit each team. This study addresses some of the concerns about the 11+ program, and coaches should be informed that it is acceptable to perform some of the program after practice.

Questions for Discussion

 Are there other barriers to the 11+ that you think exist?  Do you think it would make a difference if the strengthening portion were performed on the field or in the weight room?

Written by: Nicole M. Cattano

Reviewed by: Jeffrey Driban

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Rescheduling Part 2 of the 11+ Reduces Injury Burden and Increases Player Compliance

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